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Substance use disorders may increase risk for mortality after prison release

In a nationwide study of Swedish prisoners, substance use disorders significantly increased rates of all-cause mortality within 5 years of release from prison, independent of sociodemographic, criminological and familial factors.

“Mortality from drug overdose has been reported to be particularly high after release from prison. However, whether substance use disorders and other psychiatric disorders are causally associated with post-release mortality is uncertain, because prisoners are usually from deprived socioeconomic backgrounds, and both criminal behavior and most psychiatric disorders tend to cluster in families,” study researcher Zheng Chang, PhD, of the University of Oxford, and colleagues wrote.

Researchers used data from several population-based registers to assess risks for all-cause and external-cause mortality after prison release among all people imprisoned since 2000 and released before Dec. 31, 2009 in Sweden. Study participants (n = 47,326) were followed from the day of release until death, emigration from Sweden or the end of the study period in December 2009.

Six percent of study participants died during a median follow-up time of 5.1 years. Median age at death was 49.1 years and the median time from release to death was 3.5 years.

Estimated risk for death within 5 years of prison release was 10.2% among men with substance use disorders (95% CI, 9.6%-10.7%) vs. 3.2% among men without substance use disorders (95% CI, 3%-3.4%).

Similarly, women with substance use disorders were more likely to die within 5 years of prison release compared to women without substance use disorders (6.5% vs. 2.6%).

The association between substance use disorders and all-cause mortality did not significantly change after adjusting for sociodemographic, criminological and familial factors, according to researchers.

“In this longitudinal cohort study, substance use disorders were associated with a substantially increased rate of mortality in people release from prison, and the association remained even when we compared siblings without substance use disorders who were also in prison, which adjusts for unmeasured genetic and environmental factors,” Chang and colleagues wrote.

In an accompanying editorial, Sarah E. Wakeman, MD, of Harvard Medical School, and Josiah D. Rich, MD, MPH, of Brown University, discuss what implications the study findings may have for the United States.

“These findings are even more alarming when considering the magnitude of risk for a country such as the USA, which has a much higher incarceration rate and far more drug-related convictions than dose Sweden,” they wrote. “The absence of care in this deeply affected population translates into high costs to society and the communities that these individuals return to. As the [study] shows, these costs also translate into avoidable deaths from a treatable disease.” – by Amanda Oldt

Disclosures: Chang and Wakeman report no relevant financial disclosures. Please see the full studies for lists of all other authors’ relevant financial disclosures.